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Begin with Section 1, where you will list all policy numbers related to your claim. If multiple policies are involved, complete a separate form for each.
In Section 2, provide detailed information about the deceased, including their name, date of birth, and cause of death. Ensure accuracy as this information is crucial for processing your claim.
Move to Section 3 to fill in your details as the beneficiary. Include your relationship to the deceased and select your citizenship status.
Choose your claim option in Section 4. Depending on your relationship and preferences, select from options like Spousal Continuance or Lump Sum Payment and complete any additional required sections.
Complete Section 5 for Income Tax Certification by providing your Social Security number or Tax ID and indicating any tax withholding preferences.
In Section 6, specify where you want payments sent. If opting for direct deposit, include banking details and attach a voided check.
Finalize by signing in Section 9 to confirm that all provided information is accurate before submitting the form along with necessary documents.
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